Abstract
AimTo determine the end-tidal CO2 (ETCO2) value that predicts a HR > 60 beats per minute (bpm) with the best sensitivity and specificity during neonatal/infant cardiopulmonary resuscitation (CPR) defined as chest compressions ± epinephrine in neonates/infants admitted to a CVICU/PICU. MethodsThis was a retrospective cohort study from 1/1/08 to 12/31/12 of all infants ≤6 month of age who received CPR and had ETCO2 documented during serial resuscitations in the pediatric (PICU) or pediatric cardiovascular intensive care units (CVICU) of Children's Medical Center of Dallas. A receiver operator characteristic (ROC) curve was generated to determine the ETCO2 cut-off with the best sensitivity and specificity for predicting HR > 60 bpm. Each ETCO2 value was correlated to the infant's HR at that specific time. ResultsCPR was provided for 165 infants of which 49 infants had quantitative ETCO2 documented so only these infants were included. The majority were in the CVICU (81%) and intubated (84%). Mean gestational age was 36 ± 3 weeks and median age (interquartile range) at time of CPR was 30 (16–96) days. An ETCO2 between 17 and 18 mmHg correlated with the highest sensitivity and specificity for return of a HR > 60 bpm. Area under the curve for the ROC is 0.835. ConclusionsThis study provides critical clinical information regarding correlation between ETCO2 values and an adequate rise in heart rate in neonates and young infants during CPR. Quantitative ETCO2 monitoring allows CPR to progress uninterrupted without need to pause to check heart rate every 60 seconds until the critical ETCO2 threshold is reached. Quantitative ETCO2 monitoring as an adjunct to cardiac monitoring during infant CPR might enhance perfusion and improve outcomes.
Highlights
Cardiovascular collapse during the neonatal period is most commonly due to asphyxia [1, 2]
Since infant cardiopulmonary resuscitation (CPR) is such a rare event in the delivery room and neonatal intensive care unit (NICU), we examined a population of infants 60 bpm during CPR
Our patient population included infants with a median age of 30 days that were in the PICU and the cardiovascular intensive care units (CVICU), with the majority of these infants having cardiac lesions
Summary
Cardiovascular collapse during the neonatal period is most commonly due to asphyxia [1, 2]. Low ETCO2 levels indicate poor cardiac output, poor cardiac perfusion pressure and predict low rates of ROSC [7, 9, 10, 11, 12, 13, 14]. This appears to be true in adults regardless of the mode of cardiac arrest [15]. If ventilation is constant and CO2 production is assumed to be very low and constant, exhaled CO2 depends on pulmonary perfusion and correlates with cardiac output [8, 17, 18]. In adults with loss of spontaneous circulation, there is a progressive decrease in ETCO2 with marked increases in ETCO2 to approximately 28 mmHg indicating ROSC during
Sign-in/Register to view highlights & summary Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a callDisclaimer: All third-party content on this website/platform is and will remain the property of their respective owners and is provided on "as is" basis without any warranties, express or implied. Use of third-party content does not indicate any affiliation, sponsorship with or endorsement by them. Any references to third-party content is to identify the corresponding services and shall be considered fair use under The CopyrightLaw.
